<!DOCTYPE html>
<html>
	<head>
		<meta charset="utf-8" />
		<meta name="viewport" content="width=device-width, initial-scale=1">
		<title>小猪先生</title>
		<link rel="stylesheet" type="text/css" href="css/bootstrap.min.css" />
		<link rel="stylesheet" type="text/css" href="css/swiper.css" />
		<link rel="stylesheet" type="text/css" href="css/main.css" />
		<link rel="stylesheet" type="text/css" href="css/form.css" />
	</head>
	<body>
		<div class="form_box">
			<p class="ft_24 fw_800 cl_555 tl_c">申请成为代理商</p>
			<form class="form_syle">
				<div class="form-group row">
					<label for="inputName" class="col-sm-2 col-form-label">申请人姓名 <span class="cl_ec2727 ft_12">&#10033</span></label>
					<div class="col-sm-9">
						<input type="text" class="form-control" id="inputName" placeholder="">
					</div>
				</div>
				<div class="form-group row">
					<label for="inputPhone" class="col-sm-2 col-form-label">申请人手机 <span class="cl_ec2727 ft_12">&#10033</span></label>
					<div class="col-sm-9">
						<input type="text" class="form-control" id="inputPhone" placeholder="">
					</div>
				</div>
				<div class="form-group row">
					<label for="inputPhone" class="col-sm-2 col-form-label">短信验证码 <span class="cl_ec2727 ft_12">&#10033</span></label>
					<div class="col-sm-9">
						<div class="input-group mb-3">
							<input type="text" class="form-control" aria-describedby="basic-addon2">
							<div class="input-group-append">
								<button class="btn code" type="button">获取验证码</button>
							</div>
						</div>
					</div>
				</div>
				<div class="form-group row">
					<label class="col-sm-2 col-form-label">申请区域 <span class="cl_ec2727 ft_12">&#10033</span></label>
					<div class="col-sm-3">
						<div class="input-group mb-3">
							<select id="inputState" class="form-control">
								<option selected>省</option>
								<option>...</option>
							</select>
						</div>
					</div>
					<div class="col-sm-3">
						<div class="input-group mb-3">
							<select id="inputState" class="form-control">
								<option selected>市</option>
								<option>...</option>
							</select>
						</div>
					</div>
					<div class="col-sm-3">
						<div class="input-group mb-3">
							<select id="inputState" class="form-control">
								<option selected>区/县</option>
								<option>...</option>
							</select>
						</div>
					</div>
				</div>

				<div class="form-group row">
					<label for="inputEmail" class="col-sm-2 col-form-label">申请人邮箱</label>
					<div class="col-sm-9">
						<input type="email" class="form-control" id="inputEmail" placeholder="">
					</div>
				</div>
				<div class="form-group row">
					<label for="inputCompanyName" class="col-sm-2 col-form-label">公司名称</label>
					<div class="col-sm-9">
						<input type="text" class="form-control" id="inputCompanyName" placeholder="">
					</div>
				</div>
				<div class="form-group row">
					<label for="inputAddr" class="col-sm-2 col-form-label">公司所在地</label>
					<div class="col-sm-9">
						<input type="text" class="form-control" id="inputAddr" placeholder="">
					</div>
				</div>
				<div class="form-group row">
					<label for="controlTextarea" class="col-sm-2 col-form-label">公司概况</label>
					<div class="col-sm-9">
						<textarea class="form-control" placeholder="请您描述您之前从事的行业,目前团队大概人数等" id="controlTextarea" rows="10"></textarea>
					</div>
				</div>
				<div class="form-group row">
					<label class="col-sm-2 col-form-label"></label>
					<div class="col-sm-9">
						<button type="submit" class="btn btn-primary fm_btn">提交</button>
					</div>
				</div>
			</form>
		</div>
		<script src="js/jquery-3.3.1.min.js" type="text/javascript" charset="utf-8"></script>
		<script src="js/bootstrap.js" type="text/javascript" charset="utf-8"></script>
		<script type="text/javascript">

		</script>
	</body>
</html>
